An evaluation of knowledge and perception of pharmacology in undergraduate oral hygiene students and recent graduates at a single higher institution in Pretoria.

INTRODUCTION: Pharmacology is an increasingly important area of study for oral hygienists, as it provides the scientific basis for safe and effective oral healthcare. However, a lack of fundamental understanding of the discipline among clinical graduates can present significant challenges. Oral hygienists require pharmacological training to meet the requirements of their scope of practice. Pharmacology knowledge assists with the diagnosis and treatment of oral conditions and forms the foundation for further clinical competency development. The knowledge and perceptions of pharmacology for pharmacy, nursing and medical students have been well documented; however, little information is present for Bachelor of Oral Hygiene (BOH) students. This paper sets out to evaluate BOH students' and recent graduates' knowledge and perceptions of pharmacology at a single higher institution in Pretoria to identify possible gaps and weaknesses. METHODS: A cross-sectional study design was used to collect data using an online questionnaire. The English-language questionnaire consisted of the self-reported perceptions and knowledge and actual knowledge of pharmacology of undergraduate BOH students and recent graduates. The questionnaire consisted of multiple choice questions, true or false questions and Likert scale questions. Ethics was obtained from the institution's Research Ethics Committee (REC 350/2021). RESULTS: Overall, the participants perceived the pharmacology module positively and understood its importance. Concerns were raised about insufficient time for studying and that assessments were more aligned to gaining factual knowledge than the development of problem-solving skills. Students rated their knowledge between 57.24% and 69.44%, with BOH III students and graduates having a statistically significant greater self-rated knowledge of antivirals, antifungals and common agents used to treat oral conditions in comparison with BOH I and BOH II students. Overall, BOH students and graduates' actual knowledge was between 45.24% and 66.84%. Although not statistically significant, the total self-rated knowledge of BOH III students and recent graduates tended to be higher than their actual knowledge. Knowledge deficits were evident with some pharmacological concepts across the various BOH groups, such as pharmacokinetics, pain, drugs altering dental treatment I: central nervous system drugs, drugs altering dental treatment II: respiratory and endocrine drugs, drugs altering dental treatment III: cardiovascular drugs, drug-drug interactions and common agents used to treat oral conditions. CONCLUSION: Self-rated knowledge deficiencies were noted by students and recent graduates for certain pharmacological concepts and were supported by the measurement of their actual knowledge. Further investigation into knowledge deficiencies is needed to guide curriculum review to further strengthen oral hygienists' pharmacological competencies and ensure alignment to their scope of practice.

A national, multicentre, web-based point prevalence survey of antimicrobial use and quality indices among hospitalised paediatric patients across South Africa.

OBJECTIVES: Data on antimicrobial consumption among the paediatric population in public hospitals in South Africa are limited. This needs to be addressed to improve future antimicrobial use and reduce antimicrobial resistance rates. This study aimed to quantify antimicrobial usage and to identify and classify which antimicrobials are used in the paediatric population in public sector hospitals in South Africa according to the World Health Organization (WHO) AWaRe list of antimicrobials. METHODS: A point prevalence survey was conducted among 18 public sector hospitals from nine provinces using a newly developed web-based application. Data were analysed according to the WHO AWaRe list to guide future quality improvement programmes. RESULTS: A total of 1261 paediatric patient files were reviewed, with 49.7% (627/1261) receiving at least one antimicrobial and with 1013 antimicrobial prescriptions overall. The top five antimicrobials included ampicillin (16.4%), gentamicin (10.0%), amoxicillin/enzyme inhibitor (9.6%), ceftriaxone (7.4%) and amikacin (6.3%). Antimicrobials from the 'Access' classification were the most used (55.9%), with only 3.1% being from the 'Reserve' classification. The most common infectious conditions for which an antimicrobial was prescribed were pneumonia (14.6%; 148/1013) and clinical sepsis (11.0%; 111/1013). Parenteral administration (75.6%; 766/1013) and prolonged surgical prophylaxis (66.7%; 10/15) were common concerns. Only 28.0% (284/1013) of prescribed antimicrobials had cultures requested; of which only 38.7% (110/284) of culture results were available in the files. CONCLUSION: Overall, antimicrobial prescribing is common among paediatric patients in South Africa. Interventions should be targeted at improving antimicrobial prescribing, including surgical prophylaxis, and encouraging greater use of oral antibiotics.

A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications.

Objectives: Antimicrobial use is growing, driven mainly by rising demands in developing countries. Knowing how antimicrobials are prescribed is important. Consequently, we undertook a point prevalence survey (PPS) quantifying antimicrobial consumption among 18 public sector hospitals across South Africa.Method: A purpose-built web-based application was used to collect PPS data.Results: Out of 4407 adult patients surveyed, 33.6% were treated with an antimicrobial. The most frequently prescribed groups were a combination of penicillins including ß-lactamase inhibitors. Amoxicillin combined with an enzyme inhibitor accounted for 21.4% total DDDs. In the medical and surgical wards, Access antimicrobials (54.1%) were mostly used, while in the ICU, Watch antimicrobials (51.5%) were mostly used. Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%; however, concerns with extended use of antimicrobials for surgical prophylaxis (73.2% of patients).Conclusion: The web-based PPS tool was easy to use and successful in capturing PPS data since the results were comparable to other PPS studies across Africa. High use of amoxicillin combined with an enzyme inhibitor, possibly because it was among the broad-spectrum antimicrobials in the Access group. The findings will assist with future targets to improve antimicrobial prescribing among public sector hospitals in South Africa.

Development of a web-based application to improve data collection of antimicrobial utilization in the public health care system in South Africa.

OBJECTIVE: Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper-based systems. A web-based application (APP) was developed in South Africa to address this, building on a recent point prevalence survey (PPS) using a paper-based system. Consequently, there was a need to test and evaluate the ease of use of a newly developed app and potential time saving versus paper-based methods for PPS. The findings can be used to further refine the APP. METHODS: The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use. RESULTS: 181 patient's files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings. CONCLUSIONS: All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in ahospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied.Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medicationerrors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) andpaediatric wards.Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients'medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered bythe nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medicationerror checklist was used to collect the data.Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients hadone or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequenttype of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of thesemedication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives(43%) and analgesics (25%) had the most errors.In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%)patients the medication error resulted in some level of harm.Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reportedelsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem inpaediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventivemeasures among the multidisciplinary team

'Esprit de corps': Towards collaborative integration of pharmacists and nurses into antimicrobial stewardship programmes in South Africa.

With the global threat of antimicrobial resistance now more emergent than ever, there should be wider collaboration between members of the multidisciplinary healthcare team. This article proposes possible ways of engagement between the pharmacist, nurse and doctor. The pharmacist and nurse are placed in an ideal position through united efforts (camaraderie) to redirect healthcare towards improved patient outcomes while also reducing antimicrobial resistance.

Delivery of pharmaceutical services at ward level in a teaching hospital.

Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are recommended. Standard operating procedures for use in the wards should be developed and implemented.